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Student Questions

  1. 1. Psy 3604.001 Exam 2: Spring 2005 Review Questions A brief note: there were a lot of great questions at the end of class today! Some of the questions seemed a little too broad for me to respond to here, so I may at times refer you to specific lecture notes or textbook sections for this lengthier information. In addition, some questions asked specifically about the upcoming exam. I don’t really have much to add about what the exam will look like, other than what I’ve said in class – the format/questions will look very similar to the first exam. Exceptions to this are that you will choose which fill-in-the-blank and short-answer questions you respond to. My responses to other questions are below: General questions: How well should we know the neurological aspects of the disorders? You want to be familiar with any major neurological/neurobiological findings related to specific disorders. I typically discuss these in class under the Etiology section of lecture. This includes neurological structures that have been connected with disorders, as well as specific mechanisms or neurotransmitters. Which treatments/methods of treatments are most important to know? In general, if I talk about treatment in lecture, you want to be familiar with it. In this unit, we actually spent a good bit of time discussing various treatments for anxiety disorders and mood disorders. It would be a good idea to study these. Otherwise, other treatments that aren’t discussed in lecture – just skim those sections in the text (have some basic familiarity). Will it be important to know the exact statistical numbers involved in the disorders? You should be familiar with prevalence rates and gender ratios. If you’re having trouble absorbing/retaining all this information, see some tips from me at the end of the study guide. Are you using abbreviations for disorders on the test? They may show up there. If there is an abbreviation on the exam that is not defined, you can ALWAYS ask myself or a TA to tell you what it stands for. Specific abbreviations people asked about: SAD = Separation Anxiety Disorder CBCL = Child Behavior Checklist
  2. 2. Cognitive Disorders: What is the etiology of delirium (causes)? Discussion of this can be found in the Cognitive Disorders lecture and Chapter 15, pp.522-523. Does dementia cause Alzheimer’s or is it a symptom? Dementia is a broad category of disorders that is broken down into subgroups based on the presumed etiology. Alzheimer’s is one of these subgroups, a type of dementia, that is presumed to be grouped together because of similar causes. Who is more at risk for dementia, is it correct that for dementia in general M=F then for Alzheimer’s F>M? Yes. The F>M discrepancy for Alzheimer’s is slight, as well. Why does dementia increase so much after the age of 45? There are a number of reasons. Older adults are typically at more risk for a variety of medical problems because of their increasingly vulnerable immune systems. They are exposed to a greater number of medications and medical procedures. In addition, some deterioration of functioning is a normal aspect of aging, so it’s related to the typical progression of development at older ages. Can you explain “neurofibrillary tangles” and “amyloid plaques”? Neurofibrillary tangles, which are strandlike fibers, and amyloid plaques, which are protein deposits, are two structures found in the brain of individuals with Alzheimer’s on autopsy. They aid in identifying cases of Alzheimer’s, and it is believed they may be a cause of some of the associated deficits. How is dementia different with various subgroup populations, such as individuals with AIDS compared to Alzheimer’s patients? It gets back to the subgroups of dementia – based on etiology. Dementia due to HIV falls under a broader category, “Dementia due to other general medical conditions.” The subgroups of dementia, which are based on etiology, can show characteristic symptoms, features, and epidemiological information as well as distinct etiologies. What is the difference between delirium and amnesia? What exactly is an amnestic disorder, and can you give us an example? Is it a dementia subtype or an individual class of disorder? A diagnosis of amnestic disorder specifically refers to an impairment in memory (see criteria and an example on p.538). Wernicke-Korsakoff syndrome is a specific type of amnestic disorder that sometimes presents in chronic alcoholics. Delirium, dementia, and amnestic disorders are all different categories.
  3. 3. What are the main differences in the cognitive disorders? I highlighted important differences in the Cognitive Disorders lecture, and the book discusses it on p. 523. Anxiety Disorders: What is the difference between a panic attack and panic disorder? What is the criteria and prevalence of Panic Disorder? There are different types of panic attacks, as we discussed in lecture. An individual must have at least one unexpected panic attack AND must have more than one attack to meet criteria for the disorder. Just having one panic attack does not qualify for panic disorder. (You might think of it like episodes:disorders in Mood Disorders – you assess the panic attacks first, then determine whether they meet criteria for the disorder). You can find information on criteria and prevalence in the Anxiety Disorders lecture and in the text, pp. 132-134. What is the difference between unexpected/uncued panic attacks vs. situationally predisposed ones? Unexpected attacks come “out of the blue,” in situations where the individual is not feeling excessively anxious and does not expect to have an attack. Situationally predisposed attacks occur when the individual is in a situation that makes them very anxious to begin with, so there is an identifiable trigger. What is the difference between panic and anxiety disorder? Panic disorder is a type of anxiety disorder. Can agoraphobia be present in more disorders other than panic disorders? It is possible to receive a diagnosis of Agoraphobia w/out history of Panic Disorder, but typically these individuals have experience panic-like symptoms in the past (never quite meeting criteria for Panic Disorder), and the agoraphobia develops in response to this. What is the difference between having Panic Disorder with Agoraphobia and without Agoraphobia? In Panic Disorder with Agoraphobia, the individual develops severe anxiety about being in situations where they might have a panic attack, or where escape might be difficult in the event of an attack. Typically, they develop a behavioral avoidance pattern because of this anxiety. It is possible to have Panic Disorder without ever developing this fear of specific panic-related situations and behavioral avoidance. What are the cultural influences for agoraphobia?
  4. 4. As we discussed in lecture, some people have suggested that the reason agoraphobia is so much more common in women than men is that anxiety/avoidance is a more culturally-accepted coping response to the panic attacks, whereas for men a more culturally-accepted coping response may be relying on intoxicating substances. Please describe the difference between Social Phobia and Agoraphobia. Good question! I’m surprised this one didn’t come up in lecture. The key is that in agoraphobia, the anxiety/avoidance is specifically in response to fear of having a panic attack. In Social Phobia, it’s more broadly related to fears of looking stupid in front of others, being evaluated by others, or humiliating oneself. Can you ever outgrow a phobia? Phobias do slightly decline with age. However, it’s important in children to distinguish between a specific phobia and normal developmentally-appropriate fears, which children do tend to outgrow. Typically, phobias are chronic (although often remit with treatment, but many don’t seek this). What characteristics of phobic disorders are found in phobias such as homophobia? The term “homophobia” was coined by a psychologist, but does not refer to the sort of clinical phobias we talk about in this class. Individuals who exhibit homophobic behavior don’t show the physiological characteristics or distress/impairment that individuals with specific phobias show. In addition, homophobia is largely rooted in a socio-cultural perspective with strong ideological roots, as opposed to the phobia being rooted primarily in the individual as a clinical entity. What is the difference between social anxiety and social phobia? You can perceive it as a matter of degree. Social anxiety is less severe, and often found in normal individuals. Social phobia is more severe, less common, and causes impairment/distress. Can you have obsessions without compulsions? Is it possible to just have compulsions and be diagnosed with OCD? Yes, to meet criteria for OCD you only have to have obsessions or compulsions. However, it is very rare for an individual to develop compulsion without obsessions, as the compulsions are usually a ‘coping response’ to the obsessions. What are hoarding subtypes in anxiety disorders? Hoarding is a specific subtype in OCD, referring to the compulsions.
  5. 5. How do behavioral, cognitive, biological/genetic models view OCD differently and the relationship to Tourette’s syndrome? They view OCD differently because they posit different mechanisms behind the development of the disorders – whether it is learned or behaviorally reinforced, whether it is due to inaccurate thought patterns or misperceptions, or whether it is caused by biological or genetic factors. These categories are NOT mutually exclusive, and could all be factors in the development of the disorder. The comorbidity between OCD and Tourette’s has prompted questions regarding whether they have a similar genetic influence. Can you explain more on the etiology of GAD? How is it hard to give a diagnosis for GAD because it’s so severe? The strongest support has come from behavior genetic studies, suggesting a substantial genetic component. Much is unknown about the etiology of GAD, but some have suggested that it may operate in a diathesis-stress fashion – inherit a genetic vulnerability and then experience significant stress in their lives. Some work is also being done to understand whether a cognitive component is involved in the development of GAD. When I discussed it in lecture, I didn’t mean to say that it’s hard to give a diagnosis of GAD. I tried to emphasize that in addition the numerous and frequent worries, a number of physiological characteristics must be associated – which makes it more difficult to get a diagnosis of GAD than someone who is just worrying, without the physiological component. Is post-partum (depression) closely related to Post-traumatic Stress Disorder? No, these are different things. “Post-partum” is a specifier that can be added to a major depressive or manic episode, if these symptoms develop within 4 wks after giving birth. The symptoms would be different than those in PTSD. Mood Disorders: In mood disorders, what exactly is the difference between an episode and a disorder? Mood disorders are described as episodic, because the symptoms tend to appear at the same time, within a given time period. Thus, an episode can be thought of as a specific period of time in which the symptoms are occurring. You must assess an individual’s various mood episodes before you determine what disorder to diagnose them with. Disorders are defined, in part, by which episodes an individual has experienced.
  6. 6. Many people said something like: The mood disorders are hard to differentiate. Could you post the graph you made in class? How about if I start it out for you again? Basically, one way to differentiate the mood disorders is by differentiating how they would be graphed on the mood continuum. Full-blown mania Hypomania Feelin’ just fine Dysthymic Severe depression BIPOLAR I BIPOLAR II Now, you sketch in the others, based on the episodes involved in the disorder: MDD Dysthymic Disorder Double depression Cyclothymic Disorder What are the differences between childhood and adult MDE? There aren’t necessarily differences, but there can be. Specifically, childhood depression can manifest as irritability rather than depressed mood. What is hypomania? A hypomanic episode shows the same symptoms as a manic episode, but it is less severe in that it is often shorter and does not cause impairment. What is the cognitive triad set forth by Aaron Beck? The book doesn’t go into it. Information on Beck’s theory can be found in the Mood Disorders lecture and in the textbook, pp. 231-232.
  7. 7. Are there neurological explanations that would determine whether a person would develop a manic vs. depressive episode? Not that I know of. Serotonin is a neurological mechanism that has been implicated in both. Can you please explain how twin studies have influenced our understanding of Mood Disorders? There’s a nice chart on p.225 of the text that illustrates these findings. The upshot is that all mood disorders show a strong genetic component, but bipolar in particular seems to show a particularly strong influence. How does mood-congruent and mood-incongruent relate to MDE? “w/ psychotic features” is an optional specifier for an MDE. Mood-congruent vs. –incongruent relates to the nature of the delusions or hallucinations, specifically whether they are consistent with the individual’s mood state. Explain the diathesis-stress model. Diathesis = predisposition Stress = environmental/life circumstance The idea is that individuals must have both to develop the disorder, not just one or the other. To be diagnosed as a mood disorder, that person has to fulfill Axis I or Axis III of DSM-IV-TR? Or both? Mood disorders are classified on Axis I. Developmental Disorders: Who is Tom Achenbach? He is a UMN PhD who developed the CBCL. Can Separation Anxiety Disorder occur in older individuals whose spouse leaves for a long period of time? Onset must be before age 18. For ADHD, can you explain how many characteristics you need out of each category and how they are related to each other. The subtypes of ADHD are correlated with each other. They are: Inattentive subtype: at least 6 inattentive symptoms Hyperactive/Impulsive subtype: at least 6 H/I symptoms Combined subtype: at least 6 from each of the above subtypes (so, at least 12 total)
  8. 8. Do you have to be diagnosed with childhood ADHD in order to be also diagnosed with adult ADHD? An onset before age 7 is required for diagnosis. Are there any theories about the mechanism by which maternal smoking increases the risk of ADHD? At this time, the mechanisms are largely unknown. What is the difference between ADHD and a Learning Disorder? The criteria for these disorders is very different – completely different symptoms. They may sometimes be misdiagnosed by parents, teachers, or doctors because both can lead to acting out behaviors in the classroom. Could you explain the difference between ODD and CD? ODD refers to oppositional and defiant behaviors that look similar to having an oppositional/defiant personality. CD refers to more severe, discrete antisocial acts that represent objective violations of societal norms or the rights of others. Is it possible for someone to improve or lose the diagnosis of autism? As mentioned in lecture, eventual prognosis correlates strongly with IQ – the higher IQ, the better chance of improvement. However, keep in mind the high comorbidity rates with MR when thinking about this effect. Are there any treatments for Autism? If you’re interested in more information on treatments of Autism, the book gives a nice summary on pp.505-507. Explain the difference between Autism and Asperger’s disorder. Difference: individuals with Asperger’s do not show the delays in language or other cognitive skills. Thus, they will show somewhat similar symptom patterns. The whole second section of autistic symptoms (“qualitative impairments in communication”) would not apply to an individual with Asperger’s. In your Asperger’s example, a man was trying to get custody of his child from an ex-wife. Asperger’s is characterized by a lack of social interaction skills. Can someone with Asperger’s still have a wife – a very substantial social relationship? Each case is different – and it is actually quite relevant to your question that he was in the process of getting a divorce, so the level of substance is questionable. An individual can get this diagnosis if their symptoms of impaired social interaction are marked impairment in nonverbal behaviors and lack of emotional reciprocity, for example.
  9. 9. If Asperger’s disorder doesn’t affect a person’s social ability, is it really considered a disorder? It must include qualitative impairment in social interaction to receive a diagnosis. How can the age of onset for MR be before the age of 18, that seems extremely old. Isn’t it chronic from birth? Yes, it is considered a chronic disorder. “Before the age of 18” refers to anytime before the age of 18, including toddlerhood and childhood. Why have diagnoses of autism increased so much these past few years? There is no good answer at this point, but some researchers suggest it is due to increased awareness upon the part of clinicians, teachers, and parents that is leading to greater identification and assessment. We do not understand what the “differing definitions” of MR mean – what are the education settings of the “educability” differing definitions of MR? The differences come into play when defining levels of MR. Educational settings define different levels from the DSM-IV, which defines different levels than the AAMR. See p. 509 for more information on these. Are we going to have to know anything specific about any of the developmental disorders that we didn’t spend much time on? You should be familiar with bold-faced terms and diagnostic criteria, and you should make sure you at least skim these sections. Whew!! Good luck studying…